Dental Care Kids - Contact Us

1500 Summer St.
Stamford, CT 06905
(203) 324-6171

Call 203-324-6171 to schedule an appointment
or
complete the following form to request an appointment.

What dates and times would you like to request?

Also, tell us what type of appointment you want, such as Cleaning & Examination, Orthodontic Exam, Treatment Previously Diagnosed, etc.:

Name:

Child's Name:

Phone:

E-mail Address:

The best time to reach me on the telephone to schedule an appointment is:

Who else in your family needs a dental appointment?
Spouse:
Patient Already?	Yes or No

Child:
Patient Already?	Yes or No

Child:
Patient Already?	Yes or No

Child:
Patient Already?	Yes or No

Comments:

For your convenience prior to visiting our office, please Click here to print the New Patient Health History Form, complete the information and bring it with you to your first visit.

To print the form you will need Adobe Acrobat Reader. If you do not have Adobe Acrobat, please click here to download it for free to your computer.

Web Site Design by Dr. Jerry Simon and Dentists4Kids.com